Bilateral THR PT before and after THR

[Zoebichon]

I have spent the last 5 months reading recovery stories here. Ever since my OS said I needed BTHR. I finally got my surgery date for May 19th.
I can see from all the stories that those who followed the BS way of no PT had far less aches and pains than those who exercised. My surgeon does not prescribe PT after THR.
I am certainly not athletic but I do love to do excersise. I was sent to PT in 2015 after being diagnosed with bilateral hip osteoarthritis. I went three times and was given lots of exercises to try.
Over the years, I have built up to doing lots of exercises with forty reps and 2 1/2 lb ankle weights and three second holds.
My OS said I am not limping (except early in the morning and at night) because my muscles are strong.
My question is how long do I wait to heal after surgery before I very slowly start strengthening again?
How atrophied will my muscles be after 6 weeks or 3 months of being mostly sedentary with just walking?
I have seen nurse Josephine caution against excersises even after five months!
I don't want to end up with chronic tendonitis issues from too early excersise.

Thanks!

 

[PolarIce]

Your body will tell you when you are ready. There is no specific timeline anyone can give you, because the recovery of each person is just so different from one person to the next. Some people started at 6 weeks and others didn't until 3 months or a bit more.
Once you have surgery, you will notice that your hip will make big bounces in progression as the weeks evolve. Most exercises that PT would normally give are range of motion only before strengthening, and the best advice I was given, and we give all the time is TAKE YOUR TIME AND DON'T PUSH IT.

Once surgery is done and you start healing, you will be able to tell on your own, when your body is ready for the next "push" or next step in physical exercises and PT exercises. For myself I tried to do them at a month, then 6 weeks but the day immediately after trying to do strength exercises, I was in agony. That's when you know you need to give your joints more time to heal. I am at 9 weeks now and only this week I have been able to do the most basic strength exercises and still feel great afterwards.

EVERYONE IS DIFFERENT. Take your time and listen to your hip. If it hurts, it's too much. Trust me, you will know as you recover what you can ask of it.

 

[Zoebichon]

Thanks polarice!

What about those very basic bed exercises that every THR patient seems to be discharged with? Are even those against the BS way?
I have read online through dozens of THR discharge protocols from surgery centers all over, even famous ones like Mayo clinic.

They all recommend post-op PT exercises and warn of dire things if not followed!
Why such discrepancy?

 

[Lynne54]

I am 2.5 weeks post THR and am only doing very basic hip exercises for range of movement only, 5 reps of 6 different exercises three times a day. If I can only manage a few reps then I do not push myself. Your hip will certainly tell you when it has done too much. Wishing you a speedy recovery after your op.

 

[subie2021]

My THR was on a Friday and I started in-home pt on Monday. Those exercises were super simple...heel-toe walking with the walker, a few seated knee raises, and the ones on the discharge info (heel slides, quad sets etc).

Two weeks later I went to my surgeon's preferred pt facility, where the therapist was familiar with his protocols. Again, very simple exercises that included a couple for balance, toe taps on a small step, and a few minutes
of pedaling on their bike thingy.

I continued there for about 3 weeks and stopped because it was very time consuming - 40 minutes drive each way - and expensive since I had copays then to pay out of pocket. I had signed up for the OneStep program from this site before surgery and have continued with it, now at 7 months post op. OneStep is perfect for me and I enjoy it very much.

My recovery has been pretty much seamless and pain free. Of course there were the usual incision and muscle aches, but nothing negative from pt. I had been active all my life with lots of physical work, but became very limited in what I could do for years because of hip issues. I lost a lot of strength and flexibility. Even walking was a challenge, because of pain but also because I had lost so much confidence in my body.

With pt my number one rule was to never do anything that caused pain. If I tried and it hurt, I stopped. If something caused pain later in the day or the next day, that exercise was either modified or put off until later in the process. I never hesitated to tell any of my therapists that something was a problem, and they never pushed me into doing it anyway. We always found work arounds.

Some folks do great without any pt at all. Some do a little, some do a lot. I think a lot depends on how debilitated or fit one might be pre-THR, age, physical goals and ambitions, whether or not one has problems with their leg post-op, etc. Sometimes getting back to normal is a matter of luck either good or bad. There isn't one correct answer for every one. From reading here at BoneSmart, I've learned that with hips, the general rule seems to be that faster is slower and slower is faster with regard to recovery. And because I've been a cranky old dame for a long time, I know that "No." is a complete sentence and it is important to use it when a therapist pushes too far.

You'll find your own answers as you progress through the hippie journey. I'd advise not to compare your recovery to anyone else's, and to go at a pace that is correct for you.

Good luck! Best wishes!

 

[djklaugh]

@Zoebichon When I had my BTHR I was sent home with just a few exercises - ankle flexes ( just bend feet back and forth), heel slides (bend knee and attempt to slide heel up to butt), and lying flat slowly and gently slide each leg outward. I'd limped for several years before my surgery and so did PT for quite a while - not because of the hips per se but because the muscles around the hips needed help. Just as an example it took me about 4 months to get left foot onto right knee -- and about 8 months to get right foot onto left knee.

My hips were really bad! Right hip had fused to my pelvis so did not move at all for a long time before surgery. In fact one of the key things to send me seeking hip replacement ( besides the pain) was when I went for a routine Gyn exam and my hips would not (ahem) "assume the position" - if you know what I mean.

The way my PT was set up with the enthusiastic YES from my PT gals was I went in every 2 weeks and did the exercises they gave me diligently between visits. My surgeon referred me for PT through my HMO insurance and said "stay with it as long as they will have you". Each visit they would drop the ones I could do easily and add some harder ones. This stretched out my insurance benefits AND was a lovely gentle and slow way to get all muscles back to proper functioning.

I'm not sure what drives the discrepancies you've noted about recommendations for PT - different schools of thought, $$$motivations, or.... I just know what has worked for myself and others and have seen people who end up worse off by pushing too hard too soon after surgery.

 

[Mojo333]

Hi @Zoebichon
Lots of great advice you have already received, but I just posted on another thread my thoughts on timelines for PT.

With PT, I realize there are criterion based phases of rehab through which patients can progress based on their ability to master exercises within each phase.
Often what I find difficult to understand about exercise protocols, as we are all different, is which patient will benefit from the exercises and at what stage of healing?
The confusion lies not in the protocols themselves, which seem to be consistently generic, but often the lack of connection to individual recoveries.
There is a huge degree of variability in conditions that result in hip pain or progress to arthroscopic procedures and I struggle with the idea that all can wake from the anaesthetic and embark on the same clinical pathway.

I also had bone on bone OA in both hips but I also have a very physical job that I managed (mostly until the end) to sustain and was in pretty good shape for the shape I was in.

You will know, I would say, after the first 6 weeks, how your healing is progessing and what you can start doing as far as strengthening and toning.
I dropped the prescribed PT which was too early and two aggressive but found that gave my healing some time and alleviated a lot of discomfort.

I did pick up some at three months or so for gait training and strengthening...although I was back to a good bit of walking after the 6 week mark.

I will be 5 years postop May 1 and am still very grateful for my two new good hips!

 

[PolarIce]

Thanks polarice!

What about those very basic bed exercises that every THR patient seems to be discharged with? Are even those against the BS way?
I have read online through dozens of THR discharge protocols from surgery centers all over, even famous ones like Mayo clinic.

They all recommend post-op PT exercises and warn of dire things if not followed!
Why such discrepancy?

Again the same answer I gave above, its going to really depend from one person to another. I was given the typical in bed exercises which were all range of motion based. I did them so I could get discharged, but once I got home I did not do them because of the amount of pain I was in. It was about 7-8 days post op before I actually started to do the exercises. I am doing incredible now just over 2 months post op(still have a ways a little ways to go to be back to where I was-and get better than I was pre-op).

There is such a difference from surgeon to surgeon in the recovery advice they give, I think because there is such a wide variance from patient to patient in their pre-op recovery.

What I feel should never change with a THR recovery regardless of who you are and where you are at in your recovery, is to only do as much as you can with your pain tolerance level. Your hip WILL tell you how much you can do at YOPUR stage of recovery.

It's great you have done so much research and reading online, because it will prepare you with a general idea of what your recovery could be like, and you will be less stressed if certain things come up.

 

[Going4fun]

Yes, I recommend you perform those small exercises that are meant to prevent blood clots. Those are fine, I think. I did those even as I followed the BS program of holding off on formal PT. I don't consider those anti-blood clot small movements to be PT.

 

[Elf1]

@Zoebichon I originally hadn't planned on going to PT but my OS wanted me to get some help with my gait. I had developed a pretty good limp prior to surgery. So I went though was very wary, especially at 3 weeks out.

The young lady I started working with was very nice and didn't really tend to push anything to difficult. She mostly worked on my balance and heel/toe walking to improve my gait. There were a few exercises that started to move into the strength side but she was very good about not having me push the limits.

Unfortunately she was transferred to another of their sites which was closer to home for her. I ended up with, I believe, it was the manager of the site. Immediately realized her patient interaction was lacking empathy and warmth.

To make a long story short, she starting messing around with my sacroiliac joints and did some manipulation. I was already aware that my SI joints are out of whack, have been for years. Not sure why she thought she should do anything as I didn't ask her to nor did it have anything to do with my gait. She ended up hurting me, had major pain in my lower back and about fell over every time I took a step from the waves of pain.

Needless to say I never went back and because of her my recovery was set back 3-4 weeks. Of course my story isn't the norm but just a reminder that if you feel the least bit uneasy just say no.

 

[Eman85]

They all recommend post-op PT exercises and warn of dire things if not followed!

I'd like to know what dire consequences there are for not torturing yourself?
With my first I was discharged with the basic bed exercise hand out sheet after being shown how to do them at the hospital. I was dumb and lucky in the fact that I knew no better but was able to do the exercises with ease. I witnessed fully grown people being bullied and just about tortured the day after their surgery. Some to the point of screams and tears. Meanwhile I could do the dreaded leg lifts easily. Fast forward to my second THR and there I was again in the group PT session. Difference this time was I was one of the ones that couldn't do the exercises. I could not make my leg comply and had log leg. Again I saw the PT bullying people over these exercises. I ignored him as I wasn't going to hurt myself for his pleasure. When home I walked and pumped my ankles, that's about it. As time went by I tried a few of the exercise movements just to be sure I was healing. I used a heel slide to fix my socks after using my sock helper. When the log leg subsided I did a leg lift to get in and out of bed. Funny thing but I had no dire consequences.

 

[Coddfish]

I was your age when I had my hip replaced. Keen runner, swimmer, gym user. The running had ground to a halt 4 months or so before surgery due to the arthritis, but I continued to swim, do aqua classes, and work with weights right up to surgery. I use a personal trainer and I had him build a programme using the physiotherapist’s exercises and started to gently work out about 3 weeks after surgery including using an exercise bike. I returned to swimming as soon as the wound healed and to aqua classes after 8 weeks, by which time I was working normally with weights. I started running after 4 months. Personally I think the Bonesmart guidance is overly cautious and that you will get out what you put in. I felt completely normal after 4 months and am now running better than I have for some years. Unfortunately I am now working through treatment for breast cancer, which is a whole new dimension…. Just glad I have had 7 months or so to get really fit and strong.

 

[Jaycey]

Personally I think the Bonesmart guidance is overly cautious and that you will get out what you put in.

Not at all overly cautious. Not everyone goes into surgery with your level of fitness. That's great you were running at 4 months out. But it is certainly not the norm.

 

[Mojo333]

I agree that we are overly cautious, as we should be when we have limited info on our members, and for the reasons Jaycey describes...
Not all are in excellent physical condition and those are often the ones who decide to "hit the ground running " and cause problems with what should be a cautious recovery.

Some suffer no serious repercussions, and many do.

Our bodies were assaulted surgically, our ball- of the ball and joint- was extricated and a titanium stem was inserted into a major weight-bearing thigh bone.
A good thing but yet a major thing.
And I want these new hips to last me for my lifetime so I was all too willing to be overly cautious, regain strength and ROM slowly.

 

[Sohowarrior]

I expect you saw my post today about my first outpatient PT session. I am being very careful but it was a great session even if you might think it was a bit aggressive two weeks in. All I can say is I am listening to my body, and my mood is the best it’s been since I walked out of the hospital. Today I feel like I am going to get my life back!

 

[TomT]

My surgeon told me PT was not necessary after hip replacement just walking will do it. He did send me home with exercises to complete. I agree with BS on this issue because this is a traumatic surgery where you had an artificial joint inserted into your thigh bone and hip joint. The last thing you want is for complications to happen to the joint before it's had a chance to grow into your bone and be set doing some activities that weren't necessary.

After surgery, my leg has gained a ton of strength from all the pain free walking and working in the gym, non impact stuff of course.

 

[Jamie]

@Zoebichon

How atrophied will my muscles be after 6 weeks or 3 months of being mostly sedentary with just walking?

There will be some atrophy, but you'll have plenty of time to regain strength once you've healed. And don't cut walking short. It's the very best exercise you can do following hip replacement surgery. You just want to be sure you start off slow and build up gradually to more time, walking outside versus in the house, walking on hilly flat surfaces, and walking on uneven surfaces. The only thing you might want to watch for a while is walking in dry sand (like on a beach). That shifting surface gives your leg and joint a real workout, so it's an activity to save for later. In the early weeks while you are healing the goal is to keep your joint loose and flexible, not to build a lot of strength. This is what works for most people. Granted you will see some folks who take a more aggressive approach to their post-op movements and exercise, but they usually will be someone who went into surgery in very good physical shape. And even these folks can get in trouble if they don't listen to their body so they are gradually increasing their exercises.

What about those very basic bed exercises that every THR patient seems to be discharged with? Are even those against the BS way?

Of course the basic bed exercises are just fine. We don't recommend that anyone just lie around and do no movement or exercises at all. The trick is to always be assessing how your body is reacting to whatever movement you do. There will be some minor pain or discomfort for sure, but lingering pain after or during exercise, trying to push through the pain, or having pain the next day are what you want to avoid.

They all recommend post-op PT exercises and warn of dire things if not followed!

Some therapists believe they must threaten patients in this way. You know your body better than anyone and you can tell whether a specific activity is good to too much for you at that particular time. Don't be afraid to let your therapist know you have limits and stop when things are too painful.

We've seen tens of thousands of patients come through BoneSmart and I've yet to see one person who had a knee or hip that "froze up" from lack of activity in recovery. After all, we have this surgery to get our lives back, not to just sit around. Most people are at the other end of the spectrum and may feel so much better with their new joint that they try to do too much too soon and end up in pain. Just listen to your body and you'll be fine.

 

[Eman85]

How atrophied will my muscles be after 6 weeks or 3 months of being mostly sedentary with just walking?

I just noticed this line of your original post. Instead of thinking about atrophy think about what the muscles will go through. Everyone thinks about the bone and the implant. What we fail to do is think about what has to be done to us in order for the bone to be worked on. Our hip joint is dislocated, which is no small order as it is in a capsule. Then our femur is rotated roughly 90* so the head points towards the hole they cut and all of the muscles have to be moved out of the way so they can work. If you look at a muscle cutaway of the body you'll see there is a large number of muscles that pass through and around the hip area. This is what causes the pain post-op and this is what the healing and recovery we go through is from. I thought it was going to be all about the bone pain from having a spike driven in.

 

[Zoebichon]

Thanks so much for all of your very thoughtful replies!
Three and a half weeks to go!

 

[djklaugh]

@Zoebichon Are you humming "Anticipation is keeping me waiting" ... I found the last few weeks before surgery quite annoying and frustrating ... I just wanted things over and done with. If you have not done so already you can read some of the BTHR threads here. Go over to the hip recovery side, look for a tag "bilateral", click on the tag itself and you will get a list of all the bilateral threads. Feel free to read any and all that take your interest. The link to mine ( old though it is) is in my signature. That will give you some ideas of what others have gone through during recovery from this life changing surgery.